For the first time, two major medical groups have backed limitations on gender-related surgical treatments for minors in the United States.
The American Medical Association, the nation’s largest organization representing doctors, on Wednesday said these procedures generally should be deferred until patients reach adulthood.
The American Society of Plastic Surgeons took a similar position on Tuesday, saying that gender-related surgeries should be delayed until age 19.
The issue has become increasingly fraught as the federal government and some states move to ban medical interventions for adolescents with gender dysphoria.
Until now, most of the nation’s medical groups have opposed efforts to restrict gender-related care, with many calling for evidence-based decisions that consider the specific needs of a patient, no matter their age.
These treatments may include puberty-blocking drugs, hormone therapies and, in rarer cases, surgeries. A review of hospital data from 2016 through 2020 identified about 3,600 patients aged 12 to 18 who had received gender-related surgery. The vast majority were mastectomies.
Some doctors have argued that minors should have access to mastectomies before age 18 because breast development takes place early in puberty; breasts are so visible and distressing that transitioning teens sometimes go to great lengths to conceal them, often binding their chests.
In publishing its new recommendations on Tuesday, the plastic surgeons’ society said its decision was based on a review of the existing science on long-term outcomes for minors who had received operations such as mastectomies.
The research, its statement said, was insufficient to show benefits and of low quality. Some studies hinted at the possibility of “treatment complications and potential harms” following irreversible procedures.
The American Medical Association said in its own announcement that it continued to support treatment for minors seeking gender-related care. But given the sparse research on the risks and benefits of surgical procedures, it concurred with the plastic surgeons.
“In the absence of clear evidence, the A.M.A. agrees with A.S.P.S. that surgical interventions in minors should be generally deferred to adulthood,” the statement said.
Other prominent medical groups, including the American Academy of Pediatrics, said on Wednesday that their positions on gender-related surgery for minors remained unchanged.
“The guidance from the American Academy of Pediatrics for health care for young people with gender dysphoria does not include a blanket recommendation for surgery for minors,” Dr. Andrew Racine, the group’s president, said in a statement.
“The A.A.P. continues to hold to the principle that patients, their families and their physicians — not politicians — should be the ones to make decisions together about what care is best for them.”
The softening of support for surgical intervention comes amid a growing medical debate over the treatments for adolescents, and a fierce backlash from the Trump administration over the past year.
In December, the federal government proposed new rules that would deny federal funding to hospitals that provided medical treatment for transgender youth.
High-profile hospitals in blue states, including Stanford Medicine and Kaiser Permanente, have stopped providing gender-related surgical procedures to minors, citing funding concerns.
And other hospitals in Washington, D.C., Los Angeles and Pittsburgh have shuttered their youth gender programs altogether. More than 25 states have enacted bans on gender-related care for minors.
At the same time, the field has been rattled by dozens of lawsuits filed by people who came to regret the gender-related procedures they underwent as teenagers.
In the first verdict of its kind, a jury in New York State last week awarded a woman $2 million in damages for a mastectomy she received as a teenager, which she said had left her disfigured.
In its previous public statements, the A.M.A. opposed efforts to restrict gender-related care for young people. And while it has not taken a position on surgical procedures specifically, in the past the group has voiced support for “interventions based on the current evidence, and that enable young people to explore and live the gender that they choose.”
An A.M.A. spokesman emphasized that the association rarely issued specific medical recommendations and that it often deferred to groups representing specialists in various fields of medicine.
The World Professional Association for Transgender Health, a nonprofit organization that promotes medical standards for gender-related care, said health providers should be allowed to consider the individual needs of a patient.
“There is no definitive age or one-size-fits-all approach for every patient, which is why they are built on case-by-case assessments, involve experts on adolescent development, and are designed to support thoughtful and ethical shared decision-making in a multidisciplinary field,” the group said in a statement.
In 2021, the group proposed guidelines that would have lowered age minimums for mastectomies for transgender youths to 15 years.
That was removed after pushback from members of the Biden administration, who argued that the guidelines could generate political backlash, and from the American Academy of Pediatrics, which said they weren’t supported by the evidence.
Azeen Ghorayshi contributed reporting.
Andrew Jacobs is a Times reporter focused on how healthcare policy, politics and corporate interests affect people’s lives.
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